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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing complex general liability claims and managing high exposure liability claims, including litigation and rehabilitation. Proficient in supervising teams, providing technical direction, and ensuring compliance with jurisdictional requirements.
Highest-signal resume keywords
Claims AnalysisHigh Exposure Liability Claims ManagementSubrogation Identification and NegotiationTeam SupervisionJurisdiction Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ExperienceTechnical DirectionClaims AdjudicationQuality ReviewDocumentation ReviewPerformance DevelopmentProcess ImprovementSettlement NegotiationClaims CodingManagement Reporting
Soft Skills
Problem SolvingClear ThinkingExcellent JudgmentStress ManagementLeadership
Tools & Technologies
Claims Management Software
Certifications & Qualifications
Required LicensesProfessional Certifications
Industry Keywords
General Liability ClaimsWorkers CompensationSubrogationLitigationRehabilitationJurisdiction KnowledgePerformance StandardsAudit StandardsClient ContactContinuous Improvement
About the role
Key responsibilities & impact- Analyze complex or technically difficult general liability claims to determine benefits due
- Handle high exposure liability claims involving litigation and rehabilitation
- Ensure ongoing adjudication of claims meets service expectations, industry best practices, and client requirements
- Identify subrogation opportunities and negotiate settlements
- Provide backup for the team lead when out of the office
- Supervise multiple teams of examiners and technical staff for workers compensation clients
- Monitor colleagues' workloads, provide training, and monitor individual claim activities
- Provide technical and jurisdictional direction on claims adjudication reports
- Maintain claim diaries, including frequent diaries for complex or high exposure claims
- Identify trends, problems, and issues and recommend courses of action
- Coordinate management projects and continuous process improvement initiatives
- Compile, review, and analyze management reports and take appropriate action
- Perform quality reviews of claims according to audit, service contract, and quality standards
- Act as second-level appeal authority for client and claimant issues and implement final dispositions
- Review reserves on high-cost claims and claims exceeding examiner authority
- Monitor third-party claims and periodically review litigated, vocational rehabilitation, questionable, and sensitive claims
- Maintain client contact, recommend actions based on claim status, and provide written claim summaries
- Ensure direct reports are properly licensed in serviced jurisdictions
- Ensure claims files are correctly coded and adequately documented
- Administer personnel policies and staffing standards
- Interview, hire, create performance development plans, and conduct performance discussions
- Provide support, guidance, leadership, and motivation to promote performance
Requirements
What you’ll need- Bachelor's degree from an accredited college or university preferred
- Required licenses for the applicable jurisdictions
- Professional certifications as applicable to line of business preferred
- Two (2) years of claims experience or equivalent combination of education and experience required
- Supervisory experience not required
- Jurisdiction knowledge: DE, IL, LA, MO, NJ, OK, TN, TX
- Ability to analyze complex or technically difficult claims
- Ability to handle workers compensation claims and high exposure liability claims involving litigation and rehabilitation
- Ability to identify subrogation and negotiate settlements
- Ability to supervise multiple teams of examiners and technical staff
- Ability to provide technical and jurisdictional direction
- Ability to review claims, reserves, reports, and documentation
- Ability to manage multiple priorities and meet deadlines
- Clear and conceptual thinking ability, excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to handle work-related stress
- Computer keyboarding skills
- Hearing, vision, and talking abilities
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Medical, dental, vision, 401K and matching
- Paid time off (PTO)
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Reasonable accommodations
- Flexible work location and career path
- Bonus eligibility may apply